SAMPLE DISCHARGE LETTER (DATE) Dear (Patient), You will recall that we discussed our physician-patient relationship in my office

on (date of last visit or discussion). Also present were your (wife, husband, etc.; and my (nurse, assistant, etc.) As we discussed, I find it necessary to inform you that I will no longer be able to serve as your doctor. The primary difficulty has been (indicate general reason, i.e. your failure to cooperate with the medical care plan, your behavior toward my staff). I recommend you promptly find another physician who can best care for your medial needs (state needs if continual medical attention is necessary, i,e, diabetes, hypertension}. You may want to contact (provide names and numbers of the state or local medical society, or physician on-call roster system) to obtain names of other physicians who may be accepting new patients. Any delay could jeopardize your health, so please act promptly. I will remain available to provide medical treatment to you, on an emergency basis only, until (date at least 30 days from the date of letter) while you have an opportunity to arrange for another physician. Once you have found another physician and we receive an appropriate authorization, I will forward a copy of your medical records. I will also be happy to discuss your case with the physician assuming your care. Enclosed, please find a copy of a medical records release authorization form for you to complete and return to my office as soon as possible. While it is unfortunate that our relationship has reached this stage, I will not be able to provide medical care of any kind to you after (date at least 30 days from this letter). Very truly yours, (your name)